Amok Syndrome

Although the actual amok syndrome is less well-known, the phrase "running amok" (or "running amuck") has become part of the common language for English speakers around the world.

Running amok is considered a rare culture-bound syndrome by current psychiatric classification systems, but there is evidence that it occurs frequently in modern industrialized societies. The historical origins of running amok as a psychiatric condition are reviewed in this article, and its relevance to modern day episodes of violent behavior is discussed. Psychotic illnesses, personality disorders, and mood disorders are all possible causes of amok, and the identification and treatment of patients who are at risk for manifesting violent behavior are discussed.

Although early psychiatrists have suggested that amok is linked to psychodynamic factors such as loss of social standing, hostility, and victim blaming, more recent investigators have described it as a behavioral syndrome with different potential causes including medical illness such as malaria or neurosyphilis. Acute intoxication has also been suggested as a possible factor in some cases. Since most clinical amok cases have been diagnosed in prisons and psychiatric hospitals, it's hardly surprising that psychiatric diagnoses such as schizophrenia and bipolar disorder are commonly found in cases. Still, it is an open question whether these diagnoses can be used to explain the extreme violence in amok episodes.

Today, amok should be viewed as one possible outcome of an individual's undiagnosed and/or untreated psychiatric condition with psychosis or severe personality pathology. Considering the large number of individuals who have psychotic psychiatric conditions, mood disorders, and personality disorders, amok is still a statistically uncommon occurrence.

Preventing episodes of amok requires early recognition of susceptible individuals and prompt treatment of the underlying psychopathologic condition. Medical intervention is virtually impossible once an individual is running amok, and the outcome of his/her violent behavior is no different today than it was 200 years ago before the advent of modern psychiatric diagnosis and treatment. The first step in intervention is identifying those individuals whose psychiatric conditions or psychosocial stressors predispose them to running amok. Identification entails assessing patients for risk factors that are known to be related to violent behavior.

Assaults continuing for minutes, hours, or even days until the amok person is killed or restrained.

In cases where amok sufferers survive, they typically fall into a deep sleep or stupor that can last for days.

After waking, the formerly amok person continues to be withdrawn or uncommunicative and is unable to recall the violence that occurred.

Diagnosis:

The psychiatric literature classifies amok as a culture-bound syndrome based on its discovery 2 centuries ago in remote primitive island tribes where culture was considered the predominant factor in its pathogenesis. The primitive groups' geographic isolation and spiritual beliefs were thought to produce a mental illness not observed elsewhere in the world. DSM-IV,which is the current consensus opinion on psychiatric diagnosis, depicts amok as a cultural phenomenon that rarely occurs today. However, characterizing amok as a culture-bound syndrome ignores the fact that similar behavior has been observed in virtually all Western and Eastern cultures, having no geographical isolation. Furthermore, the belief that amok rarely occurs today is contrary to evidence that similar episodes of violent behavior are more common in modern societies than they were in the primitive cultures where amok was first observed.

Treatment:

Proper treatment of the patient at risk for running amok requires that the clinician make an accurate diagnosis that can be used to determine which treatment modalities are best suited for each patient. To date, there is no medication that has been proven to specifically treat violent behavior, and since violence results from multiple factors, it is unlikely that any such medication will be developed in the near future. The mass violence observed in running amok may be caused by a variety of psychiatric conditions, and medical treatment should therefore be aimed at a diagnosable mental disorder or a personality disorder.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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